Is Intra-articular Injection of Hyaluronic Acid, Corticosteroid or Platelet-rich Plasma Following Medical Ozone Superior to Medical Ozone Alone in the Treatment of Temporomandibular Joint Osteoarthritis?

Abstract

Background: Temporomandibular joint osteoarthritis (TMJ-OA) results in pain, limited function, and reduced quality of life. Medical ozone (MO) has been used to reduce TMJ pain and improve maximum incisal opening (MIO). However, it remains unclear whether intra-articular (IA) hyaluronic acid (HA), corticosteroid (CS), or platelet-rich plasma (PRP) injection following IA MO injection alone is superior to IA MO injection alone.

Purpose: The purpose of this study was to measure and compare pain reduction and improved MIO in subjects with TMJ-OA who underwent IA injections with MO, MO + HA, MO + CS, and MO + PRP.

Study design: The researchers implemented a randomized clinical trial in adult patients with TMJ-OA, Wilkes IV and V, referred to the author's clinic from January 2022 through December 2024.

Predictor variable: The predictor variables were the agents for IA injection. Subjects were randomized to one of 4 injection groups: MO, MO + HA, MO + CS, or MO + PRP.

Main outcome variables: The outcome variables were changes in the pain measured using the visual analog scale and range of motion (MIO) from baseline (T0) to 6 months (T2) postoperatively.

Covariates: Covariates were age and sex.

Analysis: The data were analyzed using repeated-measure analysis of variance and the Tukey-HSD test with significance set at P < .05.

Results: The final study sample included 49 patients (mean age, 32.25 ± 13.17 years), with higher female prevalence: 11 (84.6%) in the MO group, 12 (100%) in the MO + HA group, and 11 (91.7%) in the MO + CS and the MO + PRP groups (P = .6). Pain reduced (p˂0.001), and MIO improved (p˂0.01) significantly in all groups. However, after estimating differences between 6 months and baseline outcomes, mean changes in the primary outcome variables showed no statistically significant differences among the 4 groups (pain, P = .6; MIO, P = .2).

Conclusions: Within the limitations of this study, combining treatments of HA, CS, or PRP with MO was not statistically significantly associated with therapeutic effects in reducing pain or improving jaw function in patients with TMJ-OA.